The new reluctance to have a facelift, a tummy tuck or a breast enlargement marks a dramatic turn away from procedures that a few years ago seemed almost commonplace.

Figures collated by the American Society for Aesthetic Plastic Surgery show that 1.9 million operations took place last year, down from 2.1 million in 2005.

One big factor cited by many plastic surgeons is the recession. As with many areas of the American economy, the biggest downturn since the Great Depression has hit many high-end consumer industries. Purely cosmetic operations, such as nose-shaping or breast enlargements, often cost thousands of dollars and are not usually covered by health insurance.

"I believe that one can credit the downturn of the economy for the decline in surgical procedures," said Dr Elliot Jacobs, a leading New York plastic surgeon.

But some say there could be something in the zeitgeist, too. Over the past decade, plastic surgery saw a massive boom. Something previously seen as the province of Hollywood royalty trickled down to the middle class. It became the subject of numerous TV shows, such as Nip/Tuck.

It was not just soap opera that fell under the surgeons' spell; reality TV shows got in on the act, too. Programmes such as Extreme Makeover and The Swan gave ordinary people a chance of free operations. The shows were not without controversy, especially The Swan -- hosted in 2004 by Ireland's Amanda Byram -- whose premise was to transform a contestant into a more beautiful person. However, both shows have been cancelled, and this year Nip/Tuck also broadcast its last episode.

Nor are celebrities immune from criticism about the plastic surgery they have undergone. Many stars receive frequent sniping in gossip columns for having operations deemed too obvious.

Recently reality-TV star Heidi Montag was on the end of an avalanche of criticism after she revealed she had had 10 plastic surgery procedures in one day.

Dr Michael Hall, a plastic surgeon in Miami Beach, said that an age of excess in the industry had come to an end, mirroring wider society. "When it comes to plastic surgery, people are now using more common sense."

However, while full-on surgical operations might be falling, the number of non-surgical cosmetic procedures is steady or rising.

There are other changes, too, reflecting both cultural and economic trends. Dr Richard Baxter, a plastic surgeon in Washington, noticed a marked decrease in the size of breast implants as the economy started to go downhill. Before the recession, fewer than a third of Dr Baxter's clients chose a B cup implant; now about half pick a B. "People have turned to more natural-looking things," he said.

The question concerning the industry now is what the longer-term trend will be.

"Has the plastic surgery bubble burst? I doubt it. As long as a woman or a man has a mirror available, there will be a continued interest in plastic surgery," said Dr Jacobs.